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Study design

ACTwatch

The study design provides a description of the research objectives, methodology, and data collection procedures. Individual study designs were developed per country.

The outlet survey studied both the public and private sectors in order to have a complete picture of the anti-malarial market within a country at the retail level. The survey was conducted approximately three times over the life of the project in each country to measure trends over time. A cross-sectional survey was conducted of outlets with the potential to stock and dispense anti-malarials to patients/caregivers. The outlet survey measured price, availability, and volumes of anti-malarial medicines and the price and availability of RDTs. The sample was based on a one-staged cluster design using probability proportion to population size, that provided nationally representative data sufficiently powered to allow for comparisons over time, between the public and private sectors and across sub-populations where stratified. The sampling strategy was designed to detect a 20 percentage point change in the primary outcome measure, availability of ACT. The cluster selected was an administrative unit with on average 10,000 to 15,000 inhabitants, such as a sub-district or parish. Stratification was determined by consulting with the Ministry of Health (MOH) in each country to identify characteristics of sub-populations that are relevant for policy consideration.

The objective of the household survey component was to monitor consumer treatment-seeking behaviour for fever. It was a population based, cross-sectional survey that took place twice over the length of the project, at baseline and end-line, either at the same time or soon after the collection of outlet survey data. It took place in the same geographical areas as the outlet survey and allowed for comparisons over time and across strata, where relevant. It was powered to detect a 20 percentage point difference in the key outcome indicator “the proportion of children under five with fever in the past two weeks who used any anti-malarial the same or next day of the onset of fever”.

The supply chain component employed quantitative and qualitative methods to study the distribution chain for anti-malarial drugs from factory gate / port of entry to consumer, mark-ups along the supply chain, market structure, including level and forms of competition, and the policy/regulatory environment. The objective was to provide policy makers with a map of the supply chain for anti-malarials and RDTs, including evidence on wholesaler volumes and the components of the consumer price in the context of the current market and policy influences on the supply chain. Data collection methods included a structured survey of wholesalers of anti-malarials and qualitative in-depth interviews throughout the distribution chain.

Here are some examples of full study designs for each research component.

FPwatch

FPwatch was a cross-sectional study that provided estimates for key family planning market indicators at the retail level. Standardized methods and questionnaires allowed for comparisons between countries to give a complete picture of the FP market.

Sampling and outlet selection: Statistical sampling was conducted in each country to select probability-proportion-to-population-size clusters with, on average, 10,000 to 15,000 inhabitants (such as a sub-district). Nationally representative outlet sites were then identified within the clusters. Further country-specific stratification, such as rural/urban designations, were determined in each country to identify relevant sub-populations.

Outlet types: The main types of outlets surveyed included public and private not for-profit health facilities, community health workers (CHWs)/health posts, private for-profit health facilities, registered and unregistered pharmacies, drug shops, and general retailers.

Eligibility criteria: Outlets were included in the survey if they

1) Had modern contraceptive commodities including oral contraceptives, emergency contraceptives, injectables, implants or IUDs in stock at the time of survey or in the previous three months, OR